BNP Evaluation Before Surgery Study

2019-10-09 09:21:39 | BioPortfolio


A prospective, multi-centre, observational study of preoperative natriuretic peptide testing for patients undergoing non-cardiac surgery conducted over four weeks.


Study rationale:

Every year about 230 million adults undergo major non-cardiac surgery around the world. In patients 45 years and older the 30-day mortality rate is 2%. One in 20 patients will have myocardial injury that contributes to subsequent 30-day mortality and morbidity up to one year after surgery.

Identification of these high-risk patients requires risk stratification. Current clinical risk stratification tools, like the Revised Cardiac Risk Index (RCRI), only have a moderate ability to identify these patients. International guidelines, like Canadian Cardiovascular Society on perioperative cardiovascular risk assessment, advocate that all patients 45yrs and older or patients >18yrs who have significant cardiovascular disease and who are coming for intermediate to high-risk surgery, should get natriuretic peptide (NP) testing. This is because raised preoperative B-type natriuretic peptides have a strong association with postoperative cardiac complications according to observational studies and meta-analyses.

However, in these patients with significant cardiovascular disease coming for intermediate to high-risk surgery it is unknown how many patients will actually have raised natriuretic peptides. That is, which group of patients have an even higher risk in this already high-risk group. Natriuretic peptide (NP) testing is also expensive. Narrowing down the number of patients that need to be tested will reduce costs and focus efforts on those patients who really need it.

Primary objectives Determine the prevalence of abnormal (raised) NP in patients with clinical risk criteria.

Secondary objective The secondary objective is to develop a risk prediction model for those patients who will need preoperative NP testing.

Study design This is a multi-centre, prospective observational study of elective adult, non-cardiac surgical patients, 45 years or older with significant cardiovascular disease conducted over a period of four weeks.

Patients will be recruited during the preoperative assessment, usually the day before surgery. Patients will have the usual standard care risk assessment. Informed consent to have NP testing can be obtained from patients who fulfil the inclusion criteria. Patients who refused consent will continue to surgery and have access to usual care provided at the hospital institution where they have been admitted.

In patients that fulfill the surgical and clinical inclusion criteria for NP testing can be done during the preoperative visit. NP tests will be sent to the laboratory and clinicians will be blinded to the results.

Based on an individual patient data meta-analysis of mixed non-cardiac surgical patients BNP≥100 or NT-proBNP≥300 will be considered above the diagnostic threshold.

Inclusion criteria The VISION study identified preoperative patient characteristics that are associated with mortality within 30 days of major non-cardiac surgery.

The patient population to be studied are elective patients for non-cardiac surgery.

1. Age ≥ 45 years of age.

2. Undergoing intermediate or major non-cardiac surgery requiring an overnight stay in hospital.

3. With at least one of the following criteria:

1. History of ischaemic heart disease/peripheral vascular disease (coronary equivalent),

2. History of stroke or transient ischaemic attack,

3. History of congestive cardiac failure,

4. Diabetes currently on an oral hypoglycaemic agent or insulin or

5. Serum creatinine >175 µmol/L (>2.0mg/dl).

Exclusion criteria

1. Patient refusal to participate.

2. Patients presenting for cardiac and obstetric or emergency surgery.

Study Design


Risk Stratification in Surgical Patients With Cardiovascular Risk Factors


Groote Schuur Hospital
Cape Town
Western Cape
South Africa


Not yet recruiting


University of Cape Town

Results (where available)

View Results


Published on BioPortfolio: 2019-10-09T09:21:39-0400

Clinical Trials [9108 Associated Clinical Trials listed on BioPortfolio]

Development of a Prognostic Tool for the Stratification of Cardiovascular Risk in Patients With Ischemic Stroke

The availability of several high-cost strategies for the prevention of cardiovascular morbidity and mortality in patients with established cardiovascular disease highlights the necessity o...

Health and Cardiovascular Risk Factors in Slums.

Cardiovascular risk factors and disease burden has been showed to affect more deeply to poorer populations. People who live in slums are the most vulnerable subgroup in the populations whe...

Dietary Intake of Whole Walnuts in Adult Subjects Under Low Cardiovascular Risk

This cross-over study investigates health effects of dietary intake of whole walnuts towards cardiovascular risk factors in adults under low cardiovascular risk. Investigators hypothesize...

Cardiovascular Health And Risk Modification in Family Health Teams

Cardiovascular diseases remain the main cause of mortality in Canada. While effective interventions are available for reducing the risk of cardiovascular disease,there continue to be gaps ...

Effectiveness of Non-pharmacological Interventions in Patients With Cardiovascular Risk Factors in Primary Care

The principal objective is analyzed whether a selective intervention no pharmacological (use of ABPM +/- prescription of physical exercise) for cardiovascular risk factors in patients with...

PubMed Articles [48620 Associated PubMed Articles listed on BioPortfolio]

CV RISK - A new relative cardiovascular risk score.

Nowadays it is recommended to use risk scores to evaluate the magnitude of cardiovascular risk in healthy people, most popular being SCORE (Europe) and Framingham and ASCVD (US). Unfortunately, they a...

Comparison between thrombotic risk scores in Essential Thrombocythemia and survival implications.

The conventional thrombotic risk stratification in Essential Thrombocythemia (ET) distinguishes patients in two risk groups based on previous thrombosis and age (< or > 60). The IPSET-thrombosis takes...

Modified Risk Stratification based on Cervical Lymph Node Metastases Following Lobectomy for Papillary Thyroid Carcinoma.

Evidence for American Thyroid Association (ATA) risk stratification stems largely from studies involving patients undergoing total thyroidectomy. We aimed to assess the risk of recurrence according to...

Role of carotid ultrasound in addition to SCORE for the cardiovascular risk stratification of patients with psoriatic arthritis.

The assessment of the cardiovascular (CV) risk is recommended in patients with chronic inflammatory rheumatic diseases. The objectives of this study were to assess the CV risk profile in a cohort of p...

Risk stratification in cardiac sarcoidosis: the tricky business of predicting the future.

In an ideal world, primary prevention defibrillators would be placed only in patients who will suffer from life-threatening ventricular arrhythmias in the future. Since electrophysiologists cannot pre...

Medical and Biotech [MESH] Definitions

A specialty concerned with the nursing care of patients suffering from disorders of the CARDIOVASCULAR SYSTEM as well as those identified as at risk for adverse cardiac or vascular events.

Restoration of functions to the maximum degree possible in a person or persons suffering from a CARDIOVASCULAR DISEASE. It also includes cardiac conditioning and SECONDARY PREVENTION in patients with elevated cardiovascular risk profile.

Loss of vascular ELASTICITY due to factors such as AGING; and ARTERIOSCLEROSIS. Increased arterial stiffness is one of the RISK FACTORS for many CARDIOVASCULAR DISEASES.

Reduction of high-risk choices and adoption of low-risk quantity and frequency alternatives.

A pyrrole and heptanoic acid derivative,HYDROXYMETHYLGLUTARYL-COA REDUCTASE INHIBITOR (statin), and ANTICHOLESTEREMIC AGENT that is used to reduce serum levels of LDL-CHOLESTEROL; APOLIPOPROTEIN B; AND TRIGLYCERIDES and to increase serum levels of HDL-CHOLESTEROL in the treatment of HYPERLIPIDEMIAS and prevention of CARDIOVASCULAR DISEASES in patients with multiple risk factors.

More From BioPortfolio on "BNP Evaluation Before Surgery Study"

Quick Search

Relevant Topics

Surgical treatments
Surgery is a technology consisting of a physical intervention on tissues. All forms of surgery are considered invasive procedures; so-called "noninvasive surgery" usually refers to an excision that does not penetrate the structure being exci...

An anesthesiologist (US English) or anaesthetist (British English) is a physician trained in anesthesia and perioperative medicine. Anesthesiologists are physicians who provide medical care to patients in a wide variety of (usually acute) situations. ...

Searches Linking to this Trial